Planning extensive esthetic restorations for anterior teeth: use of waxed-up study casts and composite resin mock-ups

The aim of this case report is to highlight the importance of appropriate planning protocols when direct composite resin restorations are used to solve extensive esthetic problems. A 30-year-old patient complained about her small maxillary anterior teeth and short upper lip. All teeth were healthy and light colored, and the patient exhibited good oral hygiene. The anterior teeth were relatively short, resulting in a compromised esthetic relationship between height and width. The maxillary and mandibular right central incisors were in an edge-to-edge relationship. After diagnostic casts and waxed-up study casts were obtained, occlusal adjustment and recontouring of the incisal and labial surfaces of the mandibular right central incisor were performed to increase overjet. To increase the volume of the upper lip, composite resin restorations were planned for the maxillary anterior teeth. To confirm that the contours and color of the new smile were acceptable to the patient, composite resin esthetic mock-ups were made directly in the mouth before the definitive procedure. After definitive restoration of the anterior teeth, additional occlusal adjustments were performed. At the 36-month follow-up, no fracturing or severe wear of the restorations was observed. The restored anterior guidance provided excellent function after 3 years of clinical service.